Okumura et al provide guidelines for the response of health care workers (HCW) to a chemical mass casualty event. These are based on experiences with the Tokyo subway sarin attack by the Aum Shinrikyo cult in 1995. The authors are from Juntendo University and St. Luke's International Hospital in Tokyo.
General steps:
(1) Triage the patient for decontamination.
(2) Adjust health care worker personal protective equipment (PPE) to reduce secondary exposure to toxins while treating the patient.
Patient Status |
Causative Agent |
Initial Decontamination |
Treatment Priority |
able to walk ("walkable") |
invisible |
self-service dry decon |
4 |
|
visible |
self-service wet showering |
3 |
|
skin irritation present |
self-service wet showering |
3 |
unable to walk ("unwalkable") |
invisible |
dry decon |
2 |
|
visible |
wet decon |
1 |
|
skin irritation present |
wet decon |
1 |
Sources of secondary exposure:
(1) fluid from gastric lavage
(2) air from lungs
(3) from clothing or skin if incomplete decontamination
(4) fluids from washing areas not reached during decontamination
If health care workers develop symptoms while caring for the patient, then
(1) additional PPE should be provided
(2) an attempt should be made to identify the source of secondary exposure so that an appropriate response can be made (increase ventilation, change decontamination procedure, alter triage or take-in process, etc.)
Specialty: Toxicology, Emergency Medicine, Critical Care
ICD-10: ,